Urinary tract infection in men (cystitis, acute prostatitis, pyelonephritis, epididymo-orchitis)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Diagnosis: any urinary tract infection in a man
Urine tests, before any antibiotic
- Urine microscopy and culture with susceptibility testing
Blood tests (prostatitis or pyelonephritis treated in the community)
- Serum creatinine with eGFR (risk factor for acute kidney injury)if neededProstatitis or pyelonephritis managed as an outpatient: only if there is a risk factor for acute kidney injury (chronic kidney disease, urological history, dehydration, treatment with a diuretic, ACE inhibitor, NSAID or aminoglycoside) [2,3].
Orchi-epididymitis
- Chlamydia trachomatis and gonococcus NAAT (PCR) on first-catch urine (sexually active man)if neededEpididymo-orchitis in a sexually active man, whatever his age, in addition to routine urine microscopy and culture; STI work-up according to risk factors [2].
- Imaging: pyelonephritis: contrast-enhanced CT of abdomen and pelvis within 48 to 72 hours (urgently if sepsis, uncontrolled pain, suspected obstruction, endo-ureteral device or acute kidney injury); prostatitis: no imaging, except sepsis (CT) or doubt about retention (suprapubic ultrasound or bladder scanner).
Also consider
- Positive urine culture without symptoms? Colonisation is not treated, except before a urological procedure: see the page “Positive urine culture without symptoms”.
Do not order
- Urine dipstick to confirm or exclude a urinary tract infection in men: not recommended in the diagnostic strategy [2,3].
- Blood test in cystitis in men: not recommended, neither PSA nor inflammatory markers [2].
- CRP and blood cultures in prostatitis or pyelonephritis treated as an outpatient: not recommended [2,3].
- PSA for the diagnosis of a urinary tract infection in men: not recommended [2,5].
- Urine microscopy and culture for isolated acute urinary retention, or for non-specific general signs in older people (confusion, acute dependence, deterioration in general condition, organ decompensation, fall) without signs of urinary tract infection: not recommended [2].
- Endorectal ultrasound in the acute phase: contraindicated (very painful) [5].
Follow-up: poor progress, then urological work-up from the first episode
Only if progress is unfavourable
- Urine microscopy and culture on treatment, with susceptibility testingif neededFever persisting beyond 72 hours despite an appropriate antibiotic, or onset of signs of severity [5].
- Prostatitis with no improvement after 72 hours of an appropriate antibiotic (persistent fever, worsening urinary signs): MRI or contrast-enhanced CT, or endorectal ultrasound, looking for a prostatic abscess.
From the first episode, away from the infection
- Urinary tract ultrasound with post-void residual measurement; IPSS score; voiding diary in case of lower urinary tract symptoms; digital rectal examination away from the episode.
- PSA (not routine; at least 3 months after the infection)if neededOnly if a measurement is indicated according to the recommendations of the French Association of Urology, and at least 3 months after the infection: prostatitis can raise PSA for up to 3 months [2,14].
Do not order
- Follow-up urine microscopy and culture, during treatment or later, if the course is favourable: not recommended, since persistent colonisation would not be treated [5]; the 2026 SPILF advises against it after clinical cure [2].
- Routine PSA after a urinary tract infection in men, or within the 3 months following it: not recommended [2,14].
Sources (15)
- Bruyère F. Prostatite aiguë bactérienne chez l'homme adulte. Prog Urol. 2010;20(11):815-817.
- SPILF, comité des référentiels, avec SFGG, AFU, SFMU, SFM, SFPT, SNFMI et CNGE. Infections urinaires masculines aiguës communautaires de l'adulte (IUMACA) : mise à jour des recommandations. Diaporama du groupe recommandations, 20 juin 2026.
- Orcel V, Putot A, Boutfol W, et al. Diagnosis of acute community-acquired bacterial urinary tract infections in adult men. Infect Dis Now. 2026;56(6S):105318.
- Lafaurie M, Bruyère F, Boutfol W, et al. Updated guidelines for management of community-acquired urinary tract infections in adult men by the French infectious disease society (SPILF). Infect Dis Now. 2026;56(6S):105312.
- Société de pathologie infectieuse de langue française (SPILF). Diagnostic et antibiothérapie des infections urinaires bactériennes communautaires de l'adulte. Mise au point, texte court, actualisation au 11 décembre 2015 ; chapitre VII « Infections urinaires masculines ».
- SPILF, comité des référentiels. Diagnostic et antibiothérapie des infections urinaires bactériennes communautaires de l'adulte : actualisation 2017 des recommandations de 2014 (diaporama, 7 février 2018). Publication associée : Caron F, Galperine T, Flateau C, et al. Practice guidelines for the management of adult community-acquired urinary tract infections. Med Mal Infect. 2018;48(5):327-358.
- National Institute for Health and Care Excellence (NICE). Urinary tract infection (lower): antimicrobial prescribing. NICE guideline NG109, 31 octobre 2018.
- Kurotschka PK, Gágyor I, Ebell MH. Acute Uncomplicated UTIs in Adults: Rapid Evidence Review. Am Fam Physician. 2024;109(2):167-174.
- Bonkat G, Kranz J, Cai T, et al. EAU Guidelines on Urological Infections. Association européenne d'urologie (EAU), édition 2026 (mise à jour partielle de mars 2026).
- Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187.
- Chirwa M, Davies O, Castelino S, et al. United Kingdom British Association for Sexual Health and HIV national guideline for the management of epididymo-orchitis, 2020. Int J STD AIDS. 2021;32(10):884-895.
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). Australian STI Management Guidelines for Use in Primary Care : Epididymo-orchitis. Page mise à jour le 30 juin 2026, consultée le 29 octobre 2026.
- Caisse nationale de l'assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 5304 et 5305 (recherche de Mycoplasma genitalium par amplification génique).
- Soudais B, Bruyère F, Forestier E, et al. Which investigations should be performed after a first episode of urinary tract infection in men? Infect Dis Now. 2026;56(6S):105315.
- National Institute for Health and Care Excellence (NICE). Urinary tract infection (recurrent): antimicrobial prescribing. NICE guideline NG112, 31 octobre 2018, mise à jour le 12 décembre 2024.